Medical Director
Core
Provide clinical review services, peer-to-peer discussions, and clinical case reviews for CareSource members.
Role type
Senior Medical Director (Managed Care)
Builds
Clinical care standards, practice guidelines, and quality improvement plans for members.
Domain
Healthcare / Managed Care
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Clinical practice experience, Medical review, Policy development, Quality improvement, Regulatory compliance, Data analysis
Preferred skills
Managed care medical review experience, Business Administration degree, Primary care residency
Technologies
Microsoft Word
Responsibilities
Conduct clinical reviews for designated members, Provide physician review for clinical appeals, Evaluate cases suspected of fraud or abuse, Develop clinical care standards and practice guidelines, Collaborate on market strategy, Support regulatory and accreditation functions
Seniority
Senior, hands-on IC